Right Leg Numbness And Foot Drop


Consult Page

36M skateboarding accident, can’t feel or move below right knee

Initial Imaging

Fig. 45.1, Anteroposterior view of a right knee x-ray demonstrates a comminuted avulsion fracture of the fibular head with fracture fragments displaced proximally approximately 2 cm near the lateral knee joint space.

Walking Thoughts

  • What was the mechanism of the trauma?

  • Are there any fractures (e.g. fibular head/neck)? Are there other associated vascular (e.g. popliteal artery), meniscal, or ligamentous injuries?

  • Are the neurological findings consistent with injury to a particular nerve? If so, what is the mechanism of nerve injury (e.g. laceration, stretch, compression)?

  • Is only a single nerve involved, or does the injury affect several nerves? Are there multiple sensory and/or motor distributions affected?

  • Is there imaging available for the entire course of the suspected affected nerve or is the imaging limited to the injured site?

  • Are there features of nerve injury on imaging (e.g. increased size of the nerve, increased size and signal of the individual fascicles, increased signal intensity of the nerve, deviation from the normal anatomical course)?

  • Based on the mechanism, preliminary clinical exam, and imaging findings, what is the expected severity of injury (e.g. neuropraxia versus axonotmesis)?

  • What is the likelihood of spontaneous recovery?

  • What is the need and timing for nerve conduction studies and/or surgical exploration and repair?

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